Use of selective factor V Leiden screening in pregnancy to identify candidates for anticoagulants.

OBJECTIVE: To improve identification of gravidas at risk for thrombosis. Venous thromboembolic complications are a major cause of maternal mortality during pregnancy. Factor V Leiden, which causes activated protein C resistance, is the most prevalent thrombophilia in white populations. However, selective screening for factor V Leiden has not been evaluated previously for identifying women who might benefit from anticoagulant prophylaxis during pregnancy. METHODS: We constructed a risk score based on major risk factors such as overweight, family history of thrombosis, previous thrombosis, cesarean delivery, and preeclampsia. A cohort of 2384 women with known factor V Leiden status was studied. Using the risk score and its distribution, we... (More)

OBJECTIVE: To improve identification of gravidas at risk for thrombosis. Venous thromboembolic complications are a major cause of maternal mortality during pregnancy. Factor V Leiden, which causes activated protein C resistance, is the most prevalent thrombophilia in white populations. However, selective screening for factor V Leiden has not been evaluated previously for identifying women who might benefit from anticoagulant prophylaxis during pregnancy. METHODS: We constructed a risk score based on major risk factors such as overweight, family history of thrombosis, previous thrombosis, cesarean delivery, and preeclampsia. A cohort of 2384 women with known factor V Leiden status was studied. Using the risk score and its distribution, we explored possible strategies of doing selective testing for factor V Leiden and their consequences. RESULTS: During the postpartum period, but not antepartum, there is a possibility of identifying women at similar risk as those with a history of thrombosis. Women with a risk score of 2 (4% of women, 0.2% risk of thrombosis) would be screened for factor V Leiden, and those with a resulting risk score of at least 3 (ie, 1.2% risk of thrombosis) would be treated for 6 weeks. Theoretically, for every 83 women treated at this risk level, one thrombotic episode might be prevented. CONCLUSION: By using a risk score, a subgroup of women who could benefit from selective factor V Leiden screening were identified postpartum. (Less)

@article{1b39607f-dd66-47e0-84e7-c9cc6c695464,
abstract = {OBJECTIVE: To improve identification of gravidas at risk for thrombosis. Venous thromboembolic complications are a major cause of maternal mortality during pregnancy. Factor V Leiden, which causes activated protein C resistance, is the most prevalent thrombophilia in white populations. However, selective screening for factor V Leiden has not been evaluated previously for identifying women who might benefit from anticoagulant prophylaxis during pregnancy. METHODS: We constructed a risk score based on major risk factors such as overweight, family history of thrombosis, previous thrombosis, cesarean delivery, and preeclampsia. A cohort of 2384 women with known factor V Leiden status was studied. Using the risk score and its distribution, we explored possible strategies of doing selective testing for factor V Leiden and their consequences. RESULTS: During the postpartum period, but not antepartum, there is a possibility of identifying women at similar risk as those with a history of thrombosis. Women with a risk score of 2 (4% of women, 0.2% risk of thrombosis) would be screened for factor V Leiden, and those with a resulting risk score of at least 3 (ie, 1.2% risk of thrombosis) would be treated for 6 weeks. Theoretically, for every 83 women treated at this risk level, one thrombotic episode might be prevented. CONCLUSION: By using a risk score, a subgroup of women who could benefit from selective factor V Leiden screening were identified postpartum.},
author = {Lindqvist, Pelle and Olofsson, Per and Dahlbäck, Björn},
issn = {1873-233X},
keyword = {Mass Screening,Predictive Value of Tests,Prenatal Care,Pregnancy,Prenatal Diagnosis : methods,Primary Prevention : methods,Reference Values,Risk Assessment,Thrombosis : prevention & control,Thrombosis : blood,Sweden,Non-U.S. Gov't,Support,Risk Factors,Sensitivity and Specificity,Female,Human,Factor V : analysis,Adult,Anticoagulants : administration & dosage,Biological Markers : blood,Cohort Studies,Comparative Study},
language = {eng},
number = {2},
pages = {332--336},
publisher = {Lippincott Williams & Wilkins},
series = {Obstetrics and Gynecology},
title = {Use of selective factor V Leiden screening in pregnancy to identify candidates for anticoagulants.},
volume = {100},
year = {2002},
}